Monetary Donation Bend, OR

Organization Name*
Federal Tax I.D. Number*
Contact Name and Title*
Address*
Street AddressAddress Line 2CityState / Province / RegionZIP / Postal Code
Contact Phone*
Contact Email*
Date of Request*
Event Name
Date of Event
Amount Requested*
Event Description
What is the mission of your organization?*
Please describe the community that the donation benefits:*
Please quantify how many community members the donation benefits, if possible:
What percentage of contribution goes to program expenses?*
What benefits/recognition would American Licorice Company receive if this donation/sponsorship were to be granted?*
• No donations will be granted unless received at least thirty (30) business days prior to event.
• All donation/sponsorship request forms must be completed in full
or will not be considered.
• Attach any additional information regarding the event/cause you wish to be considered.
• American Licorice Company will do its best to support you in your efforts to achieve a successful event, although we may not be able to fulfill your request OR we may not be able to fulfill your request in its entirety.
File

For Information on the Black Licorice Recall, click here.